Barcelona, Spain — The most recent statistics from the American Society for Aesthetic Plastic Surgery indicate that the use of hyaluronic acids alone as soft dermal fillers grew almost 700 percent from 2004 to 2005, and the addition of other types of soft tissue fillers brings the growth figure close to 1,000 percent, according to Jeffrey M. Kenkel, M.D., associate professor and vice chairman of the department of plastic surgery at the University of Texas Southwestern Medical Center and director of the Clinical Center for Cosmetic Laser Treatment in Dallas.
"Dermal fillers are part of a rapidly changing market, and the next six to 12 months will probably bring additional choices to the table. What we're seeing right now, however, are the hyaluronic acid fillers versus products such as Sculptra and Radiesse," Dr. Kenkel says. Captique is the newest hyaluronic acid entry into the U.S. dermal filler marketplace. It is indicated for the correction of moderate to severe facial wrinkles and is manufactured by Genzyme. Inamed is Genzyme's exclusive U.S. marketing and distribution partner for Captique. Sculptra (Dermik) is also a hot commodity, according to Dr. Kenkel.
"While Sculptra is only approved for HIV-induced lipoatrophy, it is commonly being used off-label as a filler," he says. Dr. Kenkel spoke about the soft filler market here during the Biennial Plastic Surgery Cruise meeting of the American Society of Plastic Surgeons.Products coming on board in the months ahead will augment the dearth of fine line filler options.
"CosmoDerm is really the only product that is approved for periorbital superficial wrinkles right now," Dr. Kenkel says. "We don't have a hyaluronic acid that is approved for fine lines around the eyes or the lateral orbit, but that is definitely something that is coming up." The possibilities include Juvederm (Inamed) or Restylane Fine Line (Q-Med Laboratories), he says.
"With either product we will be able to inject a lot more superficial than we are right now. We'll be able to take care of some of those really fine lines around the eyes and the mouth with those products. I'm really excited about them," he says.
Juvederm available Already available internationally, Juvederm is a highly purified hyaluronic acid in the form of a viscoelastic gel. It is transparent and homogeneous, and counts among its advantages that it is of non-animal origin, does not require any prior skin testing and consists of molecules that are highly bio-compatible.
In Canada, Juvederm is available in three concentrations, and is supplied to physicians in ready-to-use, pre-filled syringes. Juvederm 18, the lightest form, fills fine wrinkles such as perioral wrinkles; Juvederm 24, the mid-density form, is used for more prominent lines, and effectively fills forehead wrinkles, glabellar lines and mild-to-moderate nasal furrows and cheek wrinkles; and the high density Juvederm 30 fills deep nasolabial folds and restores volume to lips, among other things.
In the meantime, Dr. Kenkel says, cosmetic surgeons are getting more experience with some of the "bulkier" agents, such as Sculptra, and longer results are being achieved.
"I'm very encouraged by some of the results that we're seeing with Sculptra, which is a really nice volume enhancer," he says. "Its manufacturer claims that studies have shown up to two years of improvement. I don't have any patients that are that far out on Sculptra, but I do have some who had nasolabial fold injections and are now nine months out, with excellent results."
The newer forms of hyaluronic acid to come will have a larger particle size, and will therefore be appropriate as a bulk filling agent, in contrast to the products that are used to fill fine lines and wrinkles, which have a finer particle size and can be injected very superficially.
"I think that some of the benefits we see with Sculptra may also be seen with the hyaluronic acids that are in the pipeline that have a larger particle size," Dr. Kenkel says.